Dietary intervention for non-obese Chinese adults with pre-diabetes: A pilot study

Dr Ho, Man Mandy   (Principal Investigator (PI))

Dr Deng Wen   (Co-Investigator)

Dr Chau Pui Hing   (Co-Investigator)

18

2019-06-01

2020-11-30

53260

Dietary intervention for non-obese Chinese adults with pre-diabetes: A pilot study

Dietary intervention, Glycaemic index, Inflammation, Insulin resistance, Pre-diabetes, Telomere

Endocrinology,Nutrition

201811159214

Seed Fund for PI Research – Basic Research

2018

Completed

Type 2 diabetes (T2DM) is a major and one of the world’s fastest growing public health problem. In 2013, T2DM affected more than 380 million around the world and the number is expected to rise to 592 million in 2035 and many cases are undiagnosed. (1) T2DM is associated with significant morbidity, including increased risk of cardiovascular diseases (CVD), stroke, retinopathy, blindness, renal failure and leg amputation, (2) which place an enormous burden on individuals, society and the healthcare system. The Asia-Pacific region carries a high disease burden, with more than 60% of the global diabetic population living in Asian region. (3) T2DM is a non-reversible, yet a preventable condition. The onset of T2DM is gradual, with most individuals progressing through a state of pre-diabetes (Pre-DM) which provides a major opportunity for healthcare providers to implement interventions to delay or prevent T2DM and its complications. Individuals with Pre-DM, defined as blood glucose levels higher than normal but lower than the diabetes threshold, are at increased risk of developing T2DM and its associated complications, such as CVD and retinopathy. (4-6) A National Survey conducted in China in 2010 revealed that 50.1% of people aged 18 or older have Pre-DM. (7) Current Pre-DM management strategies mostly focus on individuals who are overweight or obese as defined by body mass index (BMI, kg/m2) and target for weight loss. (8) However, recent data have indicated that a substantial proportion of individuals with pre-diabetes are non-obese. The US National Health and Nutrition Examination Survey revealed that the prevalence of Pre-DM among healthy weight adults (with a body mass index, BMI between 18.5 to 24.9) aged 45 years and older increased from 22.0% in 1988-1994 to 33.1% in 2012.(9) A study conducted in 4071 rural Chinese women reported that 40% of the non-obese (BMI<25) women aged 20 years had Pre-DM. (10) The typical strategies for management of Pre-DM which focus on caloric restriction and weight reduction may not be appropriate for individuals who are not overweight/obese. Diet plays an important role in the management of Pre-DM. Currently, no specific diet is recommended for non-obese individuals with Pre-DM. Carbohydrate is the main dietary component affecting human insulin secretion and glucose homeostasis. Observational studies reported that diet with high dietary glycaemic index (GI) and glycaemic load (GL) may increase the risk of T2DM and cardiovascular complications. (11, 12) A population-based prospective study conducted in Southwest China reported that a higher dietary GI or GL was associated with less favourable glucose homeostasis in Chinese adults without T2DM. The published evidence are either based on the obese/overweight populations or the general population. To our knowledge, no study has examined the effect of low GI diet in the non-obese individuals with Pre-DM. This pilot study aims to explore for the feasibility and effect of an increased protein and low GI diet on insulin resistance and metabolic profiles in non-obese Chinese adults with Pre-DM. The specific objectives of this pilot study are: 1.To evaluate the feasibility of developing a low glycaemic index (GI) diet plan compatible with Asian diet for non-obese Chinese adults with Pre-DM; 2.To explore the effect of a low glycaemic index (GI) diet on insulin resistance, inflammation and metabolic profiles in non-obese Chinese adults with Pre-DM.